Pathways of care: a qualitative study of barriers and facilitators to engaging dementia care among underserved and minority populations in the US and Germany

The impact of game play on dementia knowledge: A student evaluation of the Dementia Inequalities Game

Background: People with dementia and carers can face many barriers, or inequalities, in accessing a diagnosis or care. These barriers are unjust and can be addressed by the right interventions, to ensure that everyone receives equitable access to diagnosis and care. A lack of knowledge about dementia in the health and social care workforce is a recognised barrier. The Dementia Inequalities Game was co-produced with people with personal, professional, and voluntary sector experiences of dementia, and offers an educational tool to educate people about dementia and associated inequalities and overcome this knowledge gap in the current and future (in training) workforce. Aims: The aim of this study was to assess the impact of playing the co-produced Dementia Inequalities Game on knowledge about dementia and associated inequalities in health care, allied health professional, nursing and psychology students.Methods: We conducted 11 game play workshops as part of regular teaching in undergraduate and postgraduate courses in psychology, nursing, occupational therapy, physiotherapy, orthoptics, and radiography at one University in the North of England. Students did not have to partake in the workshops. Participating students completed a brief before and after knowledge questionnaire about dementia and inequalities. Paired samples t-tests were used to compare ratings of knowledge of dementia and associated inequalities before and after game play.Findings: Three-hundred-and-eighteen students took part in the workshops, with 312 fully completed questionnaires. The largest cohort of students (49%) were studying for a degree in nursing. Playing the game significantly increased knowledge about dementia (p < .001) and dementia inequalities (p < .001).Implications: Playing the Dementia Inequalities Game is an effective tool to improve knowledge about dementia and associated inequalities in health care and psychology students. Using the game as an educational and sociable intervention in health and social care professionals is a next avenue to test.

Care Partner Burden and Support Services in Dementia

OBJECTIVE

Informal care partners are essential to the care of people living with dementia, but they often experience significant burden and receive minimal training, support, and resources. This article provides an overview of care partner experiences, factors contributing to burden, and methods for reducing burden of caregiving in dementia.

LATEST DEVELOPMENTS

The US Department of Health and Human Services National Plan to Address Alzheimer's Disease and the World Health Organization Global Action Plan for dementia have identified support for dementia care partners as a top priority for research and policy in recognition of care partners' instrumental but underresourced role in dementia care. The psychological, financial, social, and physical costs of caregiving, particularly without necessary knowledge, skills, and resources, can lead to care partner burden. Reassuringly, multicomponent interventions can mitigate burden and other negative consequences of caregiving, especially when they are theoretically grounded, inclusive, and culturally relevant.

ESSENTIAL POINTS

Health care providers play a vital role in the early identification of care partner burden through brief, regular assessments. With earlier identification and subsequent intervention (eg, education, skills-based training, local and national resources), the experience of burden and negative health outcomes can be mitigated and quality of life for people living with dementia and their care partners can be improved.

"Necessity is the mother of invention": Experiences of accessing and delivering dementia-related support services by information communication technology during the pandemic in the UK

INTRODUCTION

The remote delivery of dementia-related support services by information communication technology, defined as any hardware or software, including the telephone and videoconferencing software, increased during the coronavirus pandemic. To guide the future use of information communication technology, this study explored the experiences of delivering and accessing social care and support services during the pandemic in the UK.

METHOD

Remote semi-structured interviews with social care and support providers, people with dementia and family carers were conducted between May-December 2022. Topic guides were co-developed with two public advisors (one former family carer, one person with dementia) and garnered information on delivering and accessing services during the pandemic. Audio recordings were transcribed verbatim. Employing a mixture of inductive and deductive analytic approaches, a thematic analysis was conducted.

RESULTS

Twenty-one interviews (n = 14 social care and support providers; n = 6 family carers; n = 2 people with dementia) were conducted. Three themes were generated: adapting to changing circumstances; responding to unmet needs by information communication technology and information communication technology should be a tool, not the default. Social care and support providers' creativity and motivation facilitated the adoption of information communication technology, however, available resources and guidance varied. While some people with dementia and family carers benefitted from accessing services by information communication technology to address some needs, the format was not suitable for everyone.

CONCLUSIONS

Beyond the coronavirus pandemic, the use of information communication technology within service delivery needs to be carefully considered, to avoid disenfranchising some people with dementia and family carers, while empowering people with the option of how to access services. Digital training and guidelines advising the use of information communication technology within service delivery may facilitate its improved use during the current landscape, and amidst future pandemics.

A systematic review on inequalities in accessing and using community-based social care in dementia

OBJECTIVES

To evaluate and synthesize the evidence base on barriers and facilitators to accessing and using community-based social care in dementia.

DESIGN

Mixed-methods systematic review.

SETTING

Community-based social care (such as day care, respite care, paid home care, and peer support groups).

PARTICIPANTS

People living with dementia and unpaid carers.

MEASUREMENTS

Seven databases were searched in March 2022, including English and German evidence published from 2000 focusing on inequalities in community-based social care for dementia across the globe. Titles and abstracts were screened by two reviewers, with all full texts screened by two reviewers also. Study quality was assessed using QualSyst.

RESULTS

From 3,904 screened records, 39 papers were included. The majority of studies were qualitative, with 23 countries represented. Barriers and facilitators could be categorized into the following five categories/themes: situational, psychological, interpersonal, structural, and cultural. Barriers were notably more prominent than facilitators and were multifaceted, with many factors hindering or facilitating access to social care linked together.

CONCLUSIONS

People with dementia and carers experience significant barriers in accessing care in the community, and a varied approach on multiple levels is required to address systemic and individual-level barriers to enable more equitable access to care for all.

Access and Use of Services by Caregivers of Older Adults: A Scoping Review of Cultural and Linguistic Diversity

Westernized countries are home to an increasingly culturally and linguistically diverse (CLD) older adult population. Informal caregivers of CLD older adults face unique challenges accessing and using home- and community-based services (HCBS). This scoping review sought to identify facilitators and barriers to access and use of HCBS for informal caregivers of CLD older adults. Arksey and O'Malley's framework guided a systematic search of five electronic databases. The search strategy retrieved 5979 unique articles. Forty-two studies met the inclusion criteria and informed this review. Facilitators and barriers were identified at three stages of using services: knowledge, access, and use of services. Findings concerning access to HCBS were subdivided into willingness and ability to access HCBS. Results emphasize the need for changes in healthcare systems, organizations, and providers to provide culturally appropriate care and improve the accessibility and acceptability of HCBS for informal caregivers of CLD older adults.

Facilitators and barriers for families caring for adults living with Alzheimer's dementia: A qualitative study

This study investigates the barriers and promoters of caring for older adults living with Alzheimer's Dementia (AD) in families. This was a qualitative study through content analysis (based on the Granheim and Lundman method), and the participants were selected using purposive sampling from the families of older adults living with AD who were receiving care in the community. We used semi-structured interviews to collect data from 32 family members. The validity and reliability of the data were assessed using the Lincoln and Guba criteria. In this study, 70.58% of primary caregivers were women. Caregiving facilitators included "Efficient family," "Capable caregiver," and "Motivated caregiver." Caregiving barriers included "Lacking awareness and knowledge," "Vulnerable family," "Older person with complex/multiple needs," and "Lack of care infrastructures." Training families and caregivers and developing care infrastructures for older adults with AD can help reduce caring barriers in older adults.